Abstract
PurposeRecurrent miscarriage (RM) is a stressful condition which gives rise to extensive diagnostic evaluation and is seen as a potentially curable maternal disease. Nevertheless, epidemiological data have shown that outcome is related to fertility. In addition to maternal age and number of preceding miscarriages, further markers derived from the past history may support counselling.MethodsObservational trial comprising 228 couples who were referred between 1996 and 2003 for immunological evaluation at maternal ages 20–39 years after three or more spontaneously conceived primary first trimester miscarriages. They were interviewed in 2005, ongoing pregnancies were followed up until birth in 2006. Past obstetric history was correlated with 2 year cumulative pregnancy and delivery rates (CPR, CDR).ResultsCPR and CDR were 206/228 (90.4 %) and 174/228 (76.4 %). Duration of infertility was associated with lower CPR (up to 3/>3 years, p < 0.01), whereas age and number of preceding losses inversely correlated with CDR (<35 years/35–39 years, p < 0.002; 3/>3 miscarriages, p < 0.002). Detection of an embryonic heart beat in 2–3 of the first three miscarriages resulted in favourable outcome (CPR: p < 0.02, CDR: p < 0.002). Prognosis was excellent in younger fertile women after three miscarriages where vital signs had been detected; under less favourable conditions not only risks for further miscarriage, but also for secondary infertility were elevated.ConclusionSecondary infertility is a feature of RM. Embryonic vital signs in preceding pregnancies are prognostic markers and should be regarded as a strong confounding factor in trials on therapeutic interventions. Prevention may be more appropriate than treatment.
Highlights
Secondary infertility is a feature of Recurrent miscarriage (RM)
About 12–15 % of clinical pregnancies end in spontaneous abortion, and an estimated 1 % of women who desire children suffer from recurrent miscarriages
According to the WHO, this term is defined as consecutive loss of three or more pregnancies up to the 20th gestational week [1], and 90 % occur in first trimester [2]
Summary
About 12–15 % of clinical pregnancies end in spontaneous abortion, and an estimated 1 % of women who desire children suffer from recurrent miscarriages. According to the WHO, this term is defined as consecutive loss of three or more pregnancies up to the 20th gestational week [1], and 90 % occur in first trimester [2]. International guidelines of the gynaecological societies adopted the WHO definition, and from the knowledge that about 50 % of losses are caused by cytogenetic abnormalities while 50 % are chromosomally normal, they followed the concept that euploid losses indicate a maternal and potentially curable disease. Embryonic factors which lead to aneuploidy are the only clearly defined cause of miscarriage, karyotypic evaluation of the abortus has not become a routine. The guidelines concentrate on evaluation of associated maternal factors deducing therapeutic options [3,4,5]. About 25–50 % of cases remain unexplained according to this model [5, 6], and cure rates have been stable for the past 60 years ranging from 55 to 85 % [7,8,9,10]
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